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Medicare has taken an aim to reward nursing homes based on their quality of care rather than quantity, and to penalize the homes that fall short. The recently implemented Skilled Nursing Facility Value-Based Purchasing Program (SNF VBP) will redistribute funds to 14,959 skilled nursing facilities across the nation, based on how many nursing home residents are readmitted to a hospital within 30 days of discharge. While the SNF VBP financially encourages quality care, there is concern that nursing homes are now more reluctant to send ill patients to the hospital in order to dodge penalization.

According to CMS data analyzed by Modern Healthcare, approximately 73% of skilled nursing facilities were financially penalized in 2018, while a mere 27% received bonuses.

A nursing home may receive a deduction in funds as severe as 2%, and a bonus as high as 1.6% in Medicare Part A payments. Nearly 20% of skilled facilities received the maximum 2% pay cut, and only 3% of facilities received the full 1.6% bonus.

Nearly every major news outlet across the nation has been following the story of a 29-year-old Arizona nursing home resident that gave birth to a baby boy at the end of December while in a vegetative state. The disturbing facts of the case continue to shed light on the internal problems of nursing homes, the horrors of sexual assault and the prevalence of caretaker abuse and neglect.

Facts of The Case

On December 29, paramedics were dispatched to Hacienda HealthCare after receiving a 911 call from a nurse stating, “The baby’s turning blue!” Later in the phone call, the nurse told the dispatcher, “We had no idea she was pregnant.”

With the Me Too movement in full swing, more and more victims of sexual abuse are finding their voices and gaining the courage to speak out against assailants. The group that is perhaps the least empowered by the new campaign is the elderly. While sexual assault runs rampant throughout nursing homes and long-term care facilities, many times, the abuse goes unreported.

Sexual Abuse: A Frequent Evil in Nursing Homes

A February 2017 CNN report detailed just how serious the problem is. Since 2000, over 16,000 complaints of sexual abuse in nursing homes and assisted living facilities have been reported. While that number appears high, officials warn that the true figure of actual assaults is likely much higher. The reported 16,000 only accounts for cases that have been looked into and resolved by state long-term care ombudsmen; it does not account for other allegations.

Over the years, Jehl Law Group has become familiar with Poplar Oaks Rehabilitation and Healthcare Center by pursuing cases against the facility for claims of abuse and neglect. Unfortunately, the problems are far from isolated and undoubtedly numerous.

In 2017 alone, the nursing home, which has a one-star rating and is ranked “Much Below Average” on Nursing Home Compare, was cited 17 times by health inspectors, which is nearly three times the state average of five complaints per year.

Moreover, the home was forced to pay a fine of $11,000 in 2017 after regulators deemed the home did not correctly handle abuse allegations relating to a resident’s fractured ankle.

A recent audit conducted by the Tennessee Comptroller rated three of four state-run veterans’ homes below average in quality of resident care. In addition to poor scores, the study also cited the homes for not reporting veteran deaths accurately or timely and not running comprehensive background checks on employees.

Unlike the two VA nursing homes in Murfreesboro and Mountain Home run by the Department of Veterans Affairs, which were under a separate, national review in June after news sites uncovered hidden VA statistics, the care facilities reviewed in this audit are run by the state of Tennessee and are located in Clarksville, Humboldt, Knoxville and Murfreesboro.

Throughout the duration of the study, which lasted from Jan. 1, 2015 to June 30, 2018, Clarksville, which opened in January 2016, scored higher overall than Humboldt, Knoxville and Murfreesboro.

According to the U.S. Centers for Disease Control, the 2017-2018 flu season was the deadliest in America since 1976. Roughly 80,000 people died from the flu last year, and an estimated 900,000 were hospitalized. Of those, 90 percent of all flu-related deaths were people 65 years and older.

The Flu Can Cause Additional Complications for the Elderly

Due to generally weaker immune systems and other pre-existing chronic health conditions, senior citizens are more likely to suffer additional health complications, including death, as a result of the flu. The influenza virus, which attacks respiratory function, can frequently lead to three further health issues.

Hospice care in the U.S. has steadily grown over the past 12 years. This end of life care, in which beneficiaries opt out of curative treatment to instead receive palliative care in the final stages of a terminal illness, costs Medicare billions. In fact, Medicare spending went up from $9.2 billion in 2006 to $16.7 billion in 2016 to accommodate the 1.4 million beneficiaries that hospice care serves.

Despite the increased spending to aid terminally ill patients, a report conducted by the Office of Inspector General (OIG) found that oftentimes, a poor level of care is provided, and necessary services are neglected. Additionally, the OIG uncovered fraudulent charges, including instances where hospices charged Medicare for services they never actually provided.

In particular, the report cited poor quality care, lack of information to beneficiaries and their families, inappropriate billing and insufficient services as four main areas in which hospices can improve.

Pressure sores, also referred to as bedsores, pressure ulcers or decubitus ulcers, are perhaps one of the most common evidences we see of nursing home abuse and neglect. Unfortunately, most elderly people are already predisposed to pressure sores due to lack of mobility and thin, fine skin.

When placed in a short-staffed long-term care facility that doesn’t have the proper resources to reposition an individual at least every two hours, bedsores are bound to develop. In fact, pressure sores can begin to form after a mere few hours of non-movement. In certain cases, if the wounds are left untreated, they may be lethal.

Bedsores most often develop in areas where the skin faces continuous pressure from being in contact with a bed or wheelchair. When an area on someone’s body is pressed against a bed without movement for an extended period of time, oxygen and blood flow to that part of the body are reduced. As cells lose oxygen, they begin to die, and as a result, the surrounding skin begins to die as well.

Nursing home evictions are all too common, and oftentimes, they have traumatic effects on residents and their family members. According to the Department of Health and Human Services, in 2015 alone, 9,192 complaints out of 140,145 total complaints were regarding discharges and evictions.

Some believe the problem is much larger than what the 9,192 complaints suggest, as many residents face eviction or early discharge without putting up a fight. Ombudsman agencies told The New York Times that out of everything, eviction-related complaints are the most voluminous category of criticisms received by state long-term care ombudsman programs.

If evictions tend to potentially magnify health problems a resident is already facing by creating additional stress and trauma, why such a high rate of discharge?

A new study in the Journal of the American Medical Directors Association, and later reported by the New York Times, indicates that some nursing homes may have found a lucrative new way to make money, through collecting extra funds from Medicare by providing excessive rehabilitation services to patients in their final weeks and days of life.

If this is the case, at least two major concerns are raised: Patients who need hospice and palliative care in their final days are not receiving it, but are rather receiving physical, occupational or speech therapy, and patients in need of rehabilitation services are potentially not receiving the appropriate level of care either, as the influx of rehabilitation patients crowds out therapists’ availability to help those in true need of their services.

The study, which was led by several professors at the University of Rochester Medical Center, found the trend to be more widespread in for-profit, rather than nonprofit, nursing homes.